Mallory-Weiss Tear Flashcards
What is a Mallory-Weiss Tear?
A longitudinal laceration in the gastric mucosa on the lesser curvature near the GE junction
- 20% straddle the junction and 5% in distal esophagus
What is the etiology of a Mallory-Weiss Tear?
Rapid increases in gastric pressures from retching/vomiting against a closed glottis cause the tear
What other condition is also commonly seen in people with a Mallory-Weiss tear?
A hiatus hernia
What are the clinical features of somebody with a Mallory-Weiss tear?
- Hematemesis with or without melena, classically following an episode of retching without blood
How are Mallory-Weiss tears managed?
- 90% stop spontaneously
- Control nausea and vomiting to allow for healing
- If persistent endoscopy with epinephrine injection, clipping or surgical repair may be warranted
How do you make the definiative diagnosis of a Mallory Weiss tear?
Endoscopy
What is an esophageal rupture? How does it differ from a Mallory-Weiss tear?
An esophageal rupture is a full thickness tear through all of the layers of the esophagus, a Mallory-Weiss tear involved only the mucosal layer.
- As a result esophageal rupture can result in mediastinitis, sepsis and death if untreated.
What causes esophageal rupture?
- 90% are iatrogenic (endoscopy, esophageal surgery)
- 10% from retching, coughing and vomiting, this subset also referred to as Boorhaave’s syndrome
What imaging studies can be performed for esophageal rupture? What are the findings?
1) X-ray: Mediastinal or peritoneal free air
2) CT Scan: Same, plus esophageal wall edema, periesophageal fluid
3) Gastrograffin (water soluable contrast esophagram): Reveals location of extraversion of contrast materials
4) Barium swallow: Shows extraversion better, but can irritate mediastinum only use if above does not locate the location of the rupture
